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Chapter 51 - Upper Respiratory Infections Flashcards

Week 2 (49 cards)

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1
Q

URI S/s

A

Starts with nasal congestion, rhinorrhea, malaise, and scratchy throat
Peak severity days 3-6, may persist to 10-12 days, most symptom free 7-10 days after start
May have generalized muscle aches but no fever
Young children can have low-grade fever for 24-48 hours
Adults with fever or high-grade fever in children suggest influenza or secondary infection (eg. sinusitis/OM)

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2
Q

URI Pathophysiology

A

Primary cause is rhinovirus (160 serotypes; Multiple strains is reason for reinfections despite immunity)
Additional viruses
- Adenovirus
- Common cold coronaviruses
- COVID-19
- Respiratory syncytial virus
- Parainfluenza virus
- Influenza viral strain
- Human Metapneumovirus

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3
Q

URI Transmission

A

Airborne/DC via secretions

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4
Q

URI Goals of Treatment

A

Symptom relief

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5
Q

URI Drug Therapy

A

Decongestants
- Oral - Pseudoephedrine HCl, Pseudoephedrine sulfate, Phenylephrine (Pseudoephedrine can make meth. FDA restrictions)
- Topical - Phenylephrine HCl, Oxymetazoline HCL
(Vasoconstrict capillaries of nasal mucous membranes to promote drainage and decrease stuffiness)

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6
Q

URI Decongestants for children under 4?

A

Not recommended. Insufficient evidence for effectiveness

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7
Q

URI Nonpharm Therapy

A

Increased fluid intake, nonmedicated cough drops, nasal saline spray, rest

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8
Q

URI Monitoring

A

Watch for secondary bacterial infection
Cardiac patients - HTN from vasoconstriction by oral decongestant
Older - more likely to have adverse rxn

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9
Q

URI Complications

A

Most common is sinusitis (0.5-2% of adults, 6-7% in children,
Otitis Media in infants (27%)
- OM can be due to middle ear/etustachian tube anatomy
- Day care children tend to have more otopathogens - more likely to develop OM with URI
Exacerbation of asthma (30-50% of adults, 60-79% of children)

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10
Q

URI Education

A

Symptom management
Proper dosing of decongestants
Abx not necessary

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11
Q

Sinusitis

A

Diagnosed by persistent URI >10 days w/o clinical improvement likely to be bacterial sinusitis

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12
Q

Sinusitis s/s

A

High fever, facial pain, purulent nasal discharge for 3-4 days
Possible “Double-sickening”; worsening of symptoms that were previously improving

Adults
- Purulent Rhinorrhea, Facial Pain/Pressure, and Nasal obstruction
- H/A that worsens when they bend over
- Cough that’s worse at night
Children; S/s will be more subtle due to lack of development of frontal sinuses
- Increased frequency of colds require careful hx check to see if this is a new infection or prolonged s/s
Both
- Puffy eyes, cough that worsens when they lie down

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13
Q

Is imaging useful in Sinusitis

A

Questionable because sinus images will look the same in viral URI and sinus infection

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14
Q

Chronic Sinusitis

A

s/s for 8-12 weeks
Confirmed with Endoscopy or CT
Multiple episodes of acute bacterial sinusitis per year

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15
Q

Sinusitis Pathophysiology (Acute)

A

Common: Streptococcus Pneumoniae (Strep P), Haemophilus Influenzae, Moraxella Catarrhalis
Rarer: Staphylococcus

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16
Q

Sinusitis Pathophysiology (Chronic)

A

Common; Staphylococcus, Gram-Neg Enteric, Anaerobic Bacteria
Rarer; Fungal (Aspergillus)

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17
Q

Sinusitis Cause Agent finding requires

A

Sinus/Endoscopic aspiration for accurate organism. Nasal mucosa culture not useful

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18
Q

Sinusitis consideration for immunocompromised pt

A

Severe infections with possible invasive extensions to eye/mouth/brain

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19
Q

Sinusitis Goals of Treatment

A

Absence of infection, free of all s/s of sinus infection

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20
Q

Sinusitis Drug

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A

First Choice ABX: Amoxicillin (PO) w or w/o clavulanate (Augmentin)
- Standard dose for bacterial sinusitis
- High-dose if patient is at risk for resistance
Alternate if allergic to Penicillins
- Adult: Doxycycline (PO) or Respiratory Fluoroquinolone (Levofloxacin/Moxifloxacin)
- Children: Gen 3 Cephalosporin (Cefdinir, Cefuroxime, Cefpodoxime)

21
Q

Sinusitis Drug if not improving in 72 hours

Study These Flashcards
A

Adults: High-dose amoxicillin-clavulanate or Fluoroquinolone (Levofloxacin/Moxifloxacin)
Children: High-dose Amoxicillin-clavulanate or gen 3 cephalosporins (listed above)

22
Q

Patient failure to respond to drug therapy indicates?

Study These Flashcards
A

Misdiagnosis or resistance
- CT/MRI to confirm dx

23
Q

Sinusitis Monitoring

Study These Flashcards
A

Should resolve in 7 days of treatment
Untreated, can lead to orbital cellulitis or brain involvement
Can exacerbate asthma

24
Q

Sinusitis Education

Study These Flashcards
A

Same as URI
Don’t go diving
If flying/driving over high altitude, use topical decongestants

25
Pharyngitis
Infection of pharynx or tonsils; Cause of Sore throat 20-30% in children, 5-15% in adults
26
Pharyngitis Causative Agent (Viral)
Adenovirus Influenza Parainfluenza Rhinovirus Coxsackievirus RSV Epstein-Barr
27
Pharyngitis Causative Agent (Bacterial)
Group A Streptococcal (GAS) most common, commonly seen in children 5-15 - Confirmed by Rapid Antigen Testing/culture
28
Pharygitis S/s
Presents sore throat, fever, Pharynx erthematous w or w/o exudate - Children: H/A, N/V, abd pain - Possible petechiae on soft palate, uvula red/swollen, strawberry tongue, confluent sandpaper rash (scarlatine rash aka scarlet fever)
29
Pharyngitis Treatment Goals
Eradicate bacteria Prevent development of Acute Rheumatic Fever (ARF) - Can be prevented if antimicrobial started within 9 days of onset of s/s
30
Pharygitis Drugs (Bacterial)
Beta-Lactams for GAS; Minimal resistance - First Line: Penicillin V or Amoxicillin (PO) - Penicillin G Benzathine (IM) can be given for children by weight Nonanyphylactic allergy to penicillin - Gen 1 Cephalosporin (Cephalexin) Type 1 Penicillin allergy - Clinamycin or Azithromycin Pharyngeal carriers of GAS - Clinamycin, Amoxicillin-Clavunalic Acid, or Penicillin w/Rifampin added on the last days of treatment
31
Pharyngitis Monitoring
ADR S/s resolution
32
Pharyngitis Outcomes
Rapid antigen test to confirm GAS S/s should improve within first 24 hours Complete treatment to prevent ARF
33
Pharyngitis Education
Antipyretics for fever/discomfort Take full therapy Warm fluids and cool, soft foods tolerated better
34
Ottis Media
Most common reason for children getting abx Most common in children <10 years Vaccine PCV7, PCY13, and Haemophilus influenzae (HiB) decreased cases of AOM
35
Ottis Media s/s
Often fever, Possible hearing loss, tinnitus, dizziness, unsteady gain, balance problems Children - Tug and poke at ear, irritable, poor sleep, Vomiting/Diarrhea
36
Ottis Media Dx
1) Moderate-Severe bulging of Temporal Membrane or new onset of orrrhea 2) Mild bulging of TM and recent onset of ear pain or intense erythema of TM ***No diagnosis of AOM in children who do not have middle ear effusion
37
Ottis Media Pathophysiology
Eustachian tube dysfunction, blocking secretion flow from middle ear to pharynx; negative pressure develops in middle ear causing reflux of bacteria into middle ear space Leads to MEE infected with nasopharyngeal bacteria Children more susceptible due to shorter/more horizontal/more flaccid eustachian tubes Risk factors - URI - Down - Cleft palate - HIV - Eskimo/Native American - Higher rate of infection in bottle vs breast fed and living with tobacco smokers - Daycare doubles odds of AOM - Immunocompromised/NG tubes
38
Ottis Media Causative Agent (Bacterial)
S Pneuimoniae H Influenzae (Most common since PCV7 and PCV13) - Approximate 90% nontypable M Catarrhalis
39
Ottis Media Causative Agent (Viral)
RSV, Rhino, Corona, Adeno, Parainfluenza found alone (4%) or as a copathogen (66%)
40
Ottis Media Treatment Goals
Clear infection from ME with abx. If effective, infection clears Treatment is empirical and may require change of abx
41
Ottis Media Drug
First Line: Amoxicillin Repeated AOM/Abx in last 30 days: Beta-lactamase stable amoxicillin/clavulanate or Betalactamase-stable cephalosporin (for penicillin allergy) Can choose to treat by waiting/observing with “safety net” prescription to use if needed
42
Ottis Media and Abx resistance
Frequent use of abx gave rise to resistance, causing reevaluation of use Almost 100% of M Catarrhalis produce beta-lactamase (resistant to amoxicillin/other penicillins) 97% of pneumococci susceptible to penicillin; Amoxicillin remains first line S Pneumoniae resistant to common macrolides More frequent in -Children attending daycare -Recurrent AOM -Younger than 2 years -Recently treated with Beta-lactamase abx
43
Ottis Media Monitoring
Effectiveness of treatment based on 2-3 montoring or Abx prescription If s/s resolve, should be reexamined - Children <2: 8-12 weeks after starting sbx - Children >2: Next scheduled wellness exam
44
Ottis media Education
Must be firm with treatment choice (observation or treatment) Reexamine if still having significant pain after 48 hours Ensure they finish treatment
45
Ottis Externa
Also known as "Swimmer's Ear" OM in external auditory canal
46
Ottis Externa S/s
Severe ear pain, starting with itching/irritation that is unilateral and localized Pinna/Tragus manipulation causes pain TM is normal but External canal is swollen
47
Ottis Externa Pathophysiology
Trauma/prolonged exposure to moisture P Aeruginosa most common, then S Aureus
48
Ottis Externa Drug
Topical Therapy - Combo med: Corticosteroids and Abx - Solo Abx - Acetic acid/alcohol drops
49

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